Browsing by Author "Mathew, Seema"
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Item Levator ani muscle injury and risk for urinary and fecalincontinence in parous women from a normal population,a cross‐sectional study(2019) Mathew, Seema; Guzmán Rojas, Rodrigo; Salvesen, Kjell A.; Volløyhaug, IngridAims: To study possible associations between levator ani muscle (LAM) injury and urinary incontinence (UI) and fecal incontinence (FI) and possible associations between bladder neck descent (BND), urethral funneling, and UI. Methods: A cross-sectional study of 608 women with first delivery in 1990 to 1997 assessed in 2013 to 2014. The Urinary Distress Inventory (UDI-6) and Colorectal Anal Distress Inventory (CRADI-8) were used to quantify symptoms (range, 0-100). The proportion of women with UI and FI was calculated. LAM injury, BND ≥25 mm, and funneling were diagnosed with transperineal ultrasound. Women with LAM injury, BND, and urethral funneling were compared to those without, using the Mann-Whitney U test (symptom scores) and multiple logistic regression analysis (UI and FI). Results: Four-hundred ninety-three (81%) women had intact LAM and 113 (19%) had LAM injury. They had similar median (range) UDI-6 score 8.3 (0-75) vs 4.2 (0-62.5), P = .35, and CRADI-8 score 6.3 (0-78.1) vs 6.3 (0-62.5), P = .90. Three hundred eleven out of six hundred (52%) women had UI and 65 of 594 (11%) had FI. This was similar for women with intact vs injured LAM; UI 53% vs 49%, P = .67; FI 11% vs 12%, P = .44 and with and without BND; stress UI 42% vs 42%, P = .93; urge UI 29% vs 35%, P = .34. Stress UI was more common in women with urethral funneling (50% vs 40%), odds ratio 1.56 (95% confidence interval: 1.03-2.37), P = .04. Conclusion: We found no associations between LAM injury and symptoms of UI and FI 15 to 24 years after the first delivery, but urethral funneling was associated with stress UI.Item Prevalence of anal sphincter defects and association with anal incontinence in women scheduled for pelvic organ prolapse surgery(2020) Mathew, Seema; Guzmán Rojas, Rodrigo; Nyhus, Maria Ø.; Salvesen, Kjell Å.; Volløyhaug, Ingrid I.Aims: Some women with pelvic organ prolapse (POP) have concomitant symptoms of anal incontinence. Our aim was to assess the prevalence of anal sphincter defects and the association with incontinence in women undergoing POP surgery. Methods: Cross-sectional study of 200 women scheduled for POP surgery. They answered yes/no and graded any symptoms of fecal and flatal incontinence on a visual analog scale (0–100). 3D/4D transperineal ultrasound was used to assess internal (IAS) and external anal sphincter (EAS) defects. A defect of ≥30° in ≥4 of 6 slices on tomographic imaging was regarded significant. The association between incontinence and sphincter defects was tested with multivariable logistic regression analysis. Results: The prevalence of any sphincter defect was 50/200 (25%). Combined IAS/EAS defect was found in 19/200 (9.5%) women, 8/200 (4.0%) had isolated IAS, and 23/200 (11.5%) had isolated EAS defects. In women with defect and intact IAS, 37% and 11% reported fecal incontinence, respectively, adjusted odds ratio (aOR) 2.3 (95% confidence interval [CI], 0.7–7.0), p = .147 and in women with defect versus intact EAS, 36% and 9% had fecal incontinence, aOR 4.0 (95% CI, 1.5–10.8), p = .005. In women with defect and intact IAS, 85% versus 43% reported flatal incontinence, aOR 5.2 (95% CI, 1.6–17.2), p = .007 and in women with defect versus intact EAS, 71% versus 43% had flatal incontinence, aOR 1.9 (95% CI, 0.8–4.5), p = .131. Conclusions: One of four women scheduled for POP surgery had an anal sphincter defect. EAS defects were associated with fecal incontinence and IAS defects were strongly associated with flatal incontinence.